Cerebral infarction during head and neck cancer surgery in two patients

Abstract

In Japan, where the population is aging, it is not unusual to perform head and neck surgery on elderly patients and patients with carotid atherosclerosis/stenosis, and such cases are expected to continue increasing. We experienced two cases of cerebral infarction, one that occurred during neck dissection for cervical lymph node metastasis of tongue cancer and the other during total laryngectomy for laryngeal cancer. In both cases, the patients were of advanced age and were considered at very high risk of cerebral infarction based on preoperative neck CT scans showing severe carotid arteriosclerosis/stenosis. No effective prophylactic measure for intraoperative cerebral infarction has been established. For patients at risk of cerebral infarction, preoperative ultrasonography should be performed for evaluation of the carotid artery, and if any unstable plaque or severe stenosis is detected, statin-based antilipidemic agents or cilostazol should be administered to minimize the risk of cerebral infarction and surgery should be performed after obtaining adequate informed consent.